ACUTE-RENAL-FAILURE AFTER CORONARY INTERVENTION - INCIDENCE, RISK-FACTORS, AND RELATIONSHIP TO MORTALITY

PURPOSE: This study set out to define the incidence, predictors, and m ortality related to acute renal failure (ARF) and acute renal failure requiring dialysis (ARFD) after coronary intervention. PATIENTS AND ME THODS: Derivation-Validation set methods were used in 1,826 consecutiv e patients undergoing coronary intervention with evaluation of baselin e creatinine clearance (CrCl), diabetic status, contrast exposure, pos tprocedure creatinine, ARF, ARFD, in-hospital mortality, and long-term survival (derivation set). Multiple logistic regression was used to d erive the prior probability of ARFD in a second set of 1,869 consecuti ve patients (validation set). RESULTS: The incidence of ARF and ARFD w as 144.6/1,000 and 7.7/1,000 cases respectively. The cutoff dose of co ntrast below which there was no ARFD was 100 mL. No patient with a CrC l > 47 mL/min developed ARFD. These thresholds were confirmed in the v alidation set. Multivariate analysis found CrCl [odds ratio (OR) = 0.8 3, 95% confidence interval (CI) 0.77 to 0.89, P < 0.00001], diabetes ( OR = 5.47, 95% CI 1.40 to 21.32, P = 0.01), and contrast dose (OR = 1. 008, 95% CI 1.002 to 1.013, P = 0.01) to be independent predictors of ARFD. Patients in the validation set who underwent dialysis had a pred icted prior probability of ARFD of between 0.07 and 0.73. The in-hospi tal mortality for those who developed ARFD was 35.7% and the 2-year su rvival was 18.8%. CONCLUSION: The occurrence of ARFD after coronary in tervention is rare (<1%) but is associated with high in-hospital morta lity and poor long-term survival. Individual patient risk can be estim ated from calculated CrCl, diabetic status, and expected contrast dose prior to a proposed coronary intervention. (C) 1997 by Excerpta Medic a, Inc.